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Missouri rates for HCPCS 0255U

Andrology (infertility), sperm-capacitation assessment of ganglioside GM1 distribution patterns, fluorescence microscopy, fresh or frozen specimen, reported as percentage of capacitated sperm and probability of generating a pregnancy score

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.20 / $53.70 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $25.70 / $38.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4.37 / $23.44 / $50.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $61.66 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $36.31 / $45.71
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.54 / $77.62 / $151.36
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $19.05 / $34.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.18 / $31.62 / $38.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.18 / $19.05 / $37.15